Jodi Nevandro, on fire service nursing

By Bree LeMaire MS, RN
July 17, 2003

How did you get into nursing and fire service nursing?

I’ve always wanted to be a nurse and started out with my LVN. An instructor told me to get into the RN program, so I did.

I became a PA in 1981 thinking it would improve my job prospects, but they weren’t using PAs that much, so I started working at the Santa Monica Hospital ER as the pre-hospital care coordinator.

I was responsible for paramedic radio communications as well as continuing education for nurses, paramedics and EMTs. That put me in touch with the fire service.

Fire service nursing is an emerging field for nurses. Two things are bringing nurses into the fire service: one, there’s a decreased availability of CE for paramedics at local hospitals. Many base hospitals have closed as a cost-cutting measure, which is where they previously obtained CE. Two, there are now regulations that fire departments do quality improvement and nurses know QI very well.

What do fire service nurses do?

Our primary role is networking and providing training mechanisms for all fire service personnel that are charged with EMS delivery. We can be involved in a number of tasks, from health and wellness advocacy to risk management, communicable disease programs, public education, TB testing and concurrent review while riding along with paramedics on calls.

Fire service nurses are able to teach all topics in the EMT and paramedic curriculum, such as BCLS, ACLS and PALS. We also do a lot of experiential teaching and hands-on demonstrations, working with mannequins and skills apparatus. That’s the best kind of learning.

One interesting thing we are involved with is “fire ground rehab.” We treat the firefighters when there is a big or a long-term fire. We’ll check vital signs and monitor for hydration/dehydration and hyperthermia, among other things.

This fire ground rehab can take place in fire camps or even the site of burning buildings in a populated area. Some departments automatically utilize fire service nurses when they have multiple patient incidents.

Who are the fire service nurses? Where do they work?

The EMS system configuration is different all over the state because of these differing groups. When you call 911, in most places, you get the fire department and most firefighters are at least EMTs. Many are paramedics, which requires more training and an internship. They are all part of the EMS system and nurses work with all parts of that system.

Many fire departments, large and small, in California have nurses working for them in some capacity. Los Angeles County Fire Department recently hired 11 nurses. L.A. City Fire Department has four nurse educators. Orange County Fire Authority employs five nurses.

What’s different about being a fire service nurse?

There are many differences, but one of the things I enjoy is going out on calls. This is a very different culture from my prior nursing. Going out on a call, we talk about the situation almost immediately afterward, review the case. What was good about it, what wasn’t. This is real-time learning.

Another thing is that we’re always current in what we’re teaching. We spent an inordinate amount of training time on smallpox and then SARS and then HIPAA (Health Insurance Portability and Accountability Act). HIPAA has to do with patient confidentiality. Where we used to be able to follow up on hospitalized cases that we’d treated in the field, that’s not as easy these days, thanks to HIPAA.

We see a lot of automobile accidents, industrial accidents, burns and pediatric seizures. Some of the top complaints that we see are chest pain, shortness of breath and altered level of consciousness [diabetic reactions, strokes, drug ODs].

Our challenge in teaching is also to keep the students excited about what they do. The nature of the work can be hard and demanding.

These EMS providers are our professional colleagues and such things as waiting in an ER can be long and tedious and it makes them unavailable to respond to other calls.

Anything you’d like to add?

Yes, I totally enjoy this work. I can set my own schedule to a great degree and I love the independence of contracting for myself and being my own boss.